Past papers 2

Question 1

Requirements of section 10 exemption in aseptics

Answer 1

NOTES Technical Learning Outcomes
Section 10 exempts a pharmacist from needing a license in certain circumstances:
-Under supervision of pharmacist and in accordance with a doctors prescription
-Preparation uses closed systems
-Licensed sterile ingredients (or manufactured in licensed facilities)
-Exp 1 week (supported by stability data)
-All activities done in accordance with NHS guidelines

Question 2

What is COSHH

Answer 2

Control of substances hazardous to health

Question 3

Put in order of biggest to smallest

QA QC GMP

Answer 3

Biggest
QA (process oriented)
GMP
QC (product oriented) 
Smallest

Question 4

NICE renal function levels
AND
ACR

Answer 4

G1 >90
G2 60–89 
G3a 45–59 
G3b 30–44 
G4 15–29
G5 <15 Kidney failure

Question 5

ACR NICE renal function levels and what is the point in them?

Answer 5

Prognostic (proteinurea)

A1 <3
A2 3-30
A3 >30 Severely increased

Question 6

First line antiemetics in PD

Answer 6

Domperidone (PO or PR)
Ondansetron (PO/IV)

Cyclizine is also fine

Question 7

Antiemetics contraindicated in PD

Answer 7

Prochlorperazine and metoclopramide

Question 8

HbA1c levels indicating diabetes

Answer 8

48

42-47 is high risk

Question 9

random BMs that would indicate diabetes

Answer 9

11

or for fasting >7mmol/L

Question 10

When does NICE offer statins to diabetes pt

and which statin

Answer 10

10 year risk >20%

Atorva 20

Question 11

For T1DM which long acting is preferred

Answer 11

Detemir BD

alternatively OD glargine or OD detemir

Question 12

When would you consider metformin in T1DM

Answer 12

BMI > 25
South African and related ethnicity
Want to use less insulin

Question 13

Wait how long after amending insulin to make another change

Answer 13

3-4 days

Question 14

BP targets in diabetes (2)

Answer 14

130/80 with target organ damage

140/90 otherwise

Question 15

BP meds in diabetes 1 and 2nd line

Answer 15

1. ACE

2. ACE + CCB/diuretic

Question 16

what is first line, rate or rhythm in AF

Answer 16

Rate

EXCEPT:
Offer rate control as the first‑line strategy to people with atrial fibrillation, except in people:
-whose atrial fibrillation has a reversible cause
-who have heart failure thought to be primarily caused by atrial fibrillation
-with new‑onset atrial fibrillation
-with atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm
-for whom a rhythm control strategy would be more suitable based on clinical judgement

Question 17

What do we use for pharmacological cardioversion

Answer 17

Flacanade (if no damage)
or amiodarone (if structural damage)

Question 18

Anticoagulation times to consider during cardioversion

Answer 18

Anticoagulate for 3 weeks before and 2 weeks after

(if onset is less than 48hours then you don’t need to anticoagulate and can just cardiovert. If its longer cardioversion will cause clots to explode everywhere out of the heart and cause a stroke)

Question 19

RATE CONTROL
what is first line??
second?

Answer 19

FIRST
Beta blocker
2nd
CCB OR if in HF/sedentary digoxin

Question 20

What would you do in a patient with AF who had an intercerabral haemhorrage

Answer 20

hold DOAC for 4-6 weeks depending on bleed risk

Restart DOAC (not warfarin as this has a higher risk of incercerebral haemorrhage)

Question 21

Compare bleeding risks of DOACs and Warfarin

Answer 21

DOACs - more GI bleeds

Warfarin - more intercranial bleeds (which are more dangerous than GI bleeds)

Question 22

Pill in the pocket -> how long would it take for AF to resolve

Answer 22

6-8 hours. If doesnt resolve in 24 hours go to a&e. Don’t take more than one dose in 24 hours.

Inform doctors when taken

Question 23

Studys that show DOACs are as good as warfarin

How long was warfarin required to be in therapeutic range?

Answer 23

ROCKET AF - rivaroxaban
ARISTOTLE - apixaban
(RE-LY - dabigatran)

70% of time warfarin was in therapeutic range

Question 24

AVERROES trial showed

Answer 24

Apixaban is better than aspirin in preventing stroke in AF